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HomeMy WebLinkAbout2025-00076227 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III HH II11II UHI U� I� II III IOU 1IHIllIDO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004045405 u, 1 U21 1 1 1 U, 1 U2 1 U, 1 u2 1 U, 1 U2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2025I 2025-00076227 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I ® ❑ RELATED PRIVATE ❑Y ®N 11 28 2025 12,—AM ❑YES El NO U1 -< N RANDALL RD Elgin mo /day/yr 02:45 ®PM FLOW CONDITION M •®10(�!MI N E O W Foothill Rd COUNTY PROPERTY ❑Y MN DOORING ❑y #OF MOTOR 0 SLOW 1 (/) Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 (g:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) FOR DAMAGEDAREA(S) 1980NT TOWED U1 Q NAME(LAST,FIRST,M) y mo 1 9 4 5 Honda HR-V 2016 00-NONE , 2 -2, DUE TO CRASH ® ❑ 13-UNDER CARRIAGE ©, ,. FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 M F 2 4 ❑Y ®SYSNEM❑UNK VINEH. O AET CRASH O 99-UUNKNOWN THER 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s.;il 6 4 COM VEH El Ea 1 0 F. FIRST CONTACT 12 7_;, , _5 *lIVes.See Sidebar U1 Z ST CHARLES IL 60174-3769 B 1 0 SR3679 IL 2026 REAR TELEPHONE IL D 0 3CZRU6H73GM734410 Allmerica Financial Allia ❑v Igl N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same AIC9951653 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuy 0 i v ❑Dv 1 9 8 9 Ford F150 2023 00-NONE ,i"j 12..-_, DUETO CRASH ❑ cg 2 x .. 13-UNDERCARRIAGE ta;l 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y MN ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraglon Value 9 g POINT OF 8 i 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 6 7 -�IOS •)ryes.See Sidebar C Z ST CHARLES IL 60174 0 1 0 PNK2043 OH 2O26 I g (p D IL D 0 1 FTEX1 EP1 PKF88339 Cincinnatti Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Dayton Freight Lines EC00573811 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 6 04 / :A / / UI 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 CO 11 1 11 ,28 �2025 02 45 ®AM in a Work Zone? ®N DIRP co 1 F PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ., v 2 0 28 99 11/28 l2025 02 46 ®pM El Construction >E R O 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Flatley. Deborah.A. 11-601 1530000526 11,28 r2025 02 53 Igi pM SLMT o N I]CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility F 2 El ARREST NAME 1 1,28 ,2025 03 20 0 PM El Unknown work zone type U1 El AM 45 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1530-Soto.Oscar 702 269-Mendiola 1) , !2 ,26 09 00 ❑PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , EN—I) - . A CMV is defined as any motor vehicle used to transport passengers or property and: Z II 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< - -----------; Not To Scale 1 - ) INDICATE ARROW ENORTH combination):or .Z�1 C ` 2 Is used or designed to transport more than 15 passengers including the driver (example:shuttle or charter bus):or 0 /k 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O < } -- i } } } transporting employees In the course of their empbyment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____J I - } 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, } } for direct compensation(example:large van used for speific purose):or 0 L L--_-a-....l Unit - t i I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m 0 I , , , _ I>' I CARRIER NAME Z ADDRESS D to 3 n t l CITY/STATE/ZIP g C; i. i. i. MOTOR CARR.ID El Interstate El Intrastate 5 1 I r 1 Unit 1 � ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. Y N?Randall?Rd USDOT NO. ILCC NO. m m xi Source of above z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE